Læknablaðið - 15.01.2002, Blaðsíða 27

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Nýr doktor í lœknisfrœði
Geðraskanir meðal aldraðra
Þann 31. maí síðastliðinn varði María Ólafsdóttir
doktorsritgerð sína við háskólann í Linköping. Rit-
gerðin heitir Dementia and Mental Disorders
Antong the Elderly in Primary Care. Andmælandi
var Anders Wimo við Karolinska institutet í Stokk-
hólmi. Hér fylgir enskt ágrip greinarinnar.
The main purpose of the present thesis was to
investigate how elderly patients with dementia and
mental disorders were managed in primary care. The
prevalence of the disease was investigated, to what
extent the patients and their disorders were detected
and treated and the approach of general practitioners
toward patients with dementia.
Patients aged 70 years and above visiting a
primary care centre (PCC) in Linköping (N=1225)
were examined with a Mini Mental Status Exami-
nation (MMSE). In a sub-sample (N=350) a com-
prehensive neuro-psychiatric examination and an
interview with a close informant were conducted.
All medical records (N=350) in the PCC were re-
viewed regarding diagnoses, medication and the
number of visits to the centre. Dementia and men-
tal disorders were diagnosed according to DSM-
III-R. A postal questionnaire was sent out to all
general practitioners (GPs) in Östergötland
(N=228) to gain information about their situation
and attitudes regarding patients with dementia.
Using the traditional cut off score of 23/24
points in the MMSE, revealed in a considerable
under-diagnosing of demented patients in this
study, leaving more than 70% of mild cases and
30% of moderate cases undetected. When using a
cut-off score of 26/27 a good criterion validity was
found. There was excellent agreement between
the testing by the social worker at the PCC and the
GP in the patient's home.
The prevalence of dementia and mental dis-
order according to the psychiatric interview was
33% (16% dementia, 17% mental disorders) The
frequency of psychiatric symptoms among those
with no mental disorder was up to 66%.
Dementia was detected in 25% of cases, depres-
sion in 12% of cases and anxiety in 30% of cases.
The most contmon psychiatric diagnosis according
to medical records was sleep disorder. Patients
with dementia were older, had more other diag-
noses as well as medication. Patients with mental
disorder had more visits to the PCC.
The GPs underestimated the occurrence of
dementia among elderly in PCC. They presented a
positive attitude to managing patients with
dementia and considered that existing drug
therapy justified an active search for patients with
dementia in primary care. Assessment of patients'
social environment and the organisation of social
support were regarded as the most difficult tasks
in the management of demented patients.
The prevalence of dementia and mental dis-
orders in an elderly PCC population is high. As
the major problem in the management of demen-
tia and mental disorder has been under-detection,
MMSE as an opportunistic qualitative screening
tool for cognitive function in this group is recom-
mended.
The formation of an effective network, to
manage the continuing care of patients with de-
mentia is essential, and a dementia co-ordinator at
the PPC would be preferable.
María Ólafsdóttir.
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